Dx. Specific DME Protocols MPMA Summer Meeting

Dx. Specific DME Dx. Specific DME ProtocolsProtocols

MPMA Summer MPMA Summer MeetingMeetingHal Ornstein, DPM, FACFASHal Ornstein, DPM, FACFAS

Chairman, AAPPMChairman, AAPPM18 Years in Private Practice18 Years in Private Practice

President of the President of the Jeff Frederick Fan ClubJeff Frederick Fan Club

REASONS TO REASONS TO FOLLOW THESE FOLLOW THESE

PROTOCOLSPROTOCOLS• Improved outcomes• Easy to follow• Medico-legal security• Improved patient compliance• Improved patient satisfaction• Patient convenience• Ease of inventorying• Consistent with standards of care

Documentation Documentation Summary, ChartSummary, Chart

Prescription or order Documentation of Therapeutic NecessitySigned Certification of Patient ReceiptChart Notes of DispenseInvoice

Documentation Documentation Summary, OfficeSummary, Office

Complaint Resolution Policy, Forms, LogComplaint Resolution Policy, Forms, Log Supplier StandardsSupplier Standards Warrantee InfoWarrantee Info Posted hoursPosted hours

DME Codes DME Codes L2999L2999 Non coveredNon covered L1902L1902 AFO gauntlet styleAFO gauntlet style L1906L1906 AFO multiligamentousAFO multiligamentous L4386L4386 AFO non-pneumatic walkingAFO non-pneumatic walking L4396L4396 AFO plantar fascia night AFO plantar fascia night

splintsplint L4360L4360 AFO pneumatic below kneeAFO pneumatic below knee L1971L1971 AFO with ankle jointAFO with ankle joint L4350L4350 AFO ankle control orthosisAFO ankle control orthosis L1932L1932 AFO dynamicAFO dynamic L1951L1951 AFO spiral, plastic, otherAFO spiral, plastic, other

DME Codes DME Codes L1940, L2210, L2330, L2820L1940, L2210, L2330, L2820

Arizona AFO, dynamic assistArizona AFO, dynamic assist L1970, L2210, L2820L1970, L2210, L2820

Richie AFO, dynamic assistRichie AFO, dynamic assist L1940, L2330, L2820L1940, L2330, L2820

Arizona AFO, standardArizona AFO, standard L1970, L2820bL1970, L2820b

Richie AFORichie AFO L1940, L2330, L2820L1940, L2330, L2820

Arizona AFO, tallArizona AFO, tall L1960, L2340, L2820L1960, L2340, L2820

Arizona AFO extendedArizona AFO extended A5501, A5506, A5503A5501, A5506, A5503

Custom molded shoes with rocker bottoms and Custom molded shoes with rocker bottoms and offset heelsoffset heels

L1940, L2330, L2820, A5501, A5506, A5503L1940, L2330, L2820, A5501, A5506, A5503 Custom molded shoe with Arizona Standard Custom molded shoe with Arizona Standard

AFOAFO

Plantar FasciitisPlantar Fasciitis

728.71728.71 Plantar fascial fibromatosisPlantar fascial fibromatosis 718.47 718.47 Plantarflexion contracture of anklePlantarflexion contracture of ankle

Plantar fasciitis: Initial Plantar fasciitis: Initial VisitVisit

Aircast AirheelSuggested Code: L2999

Patient Pays

PowerStep InsertSuggested Code: L2999

Patient Pays

Plantar fasciitis: Plantar fasciitis: Subsequent VisitSubsequent Visit

Night Splint, posterior or dorsalSuggested Code: L4396DMEPOS Fee Ceiling: $180

Mild

Ossur Formfit Ossur AirformOssur Exoform

Plantar fasciitis: Plantar fasciitis: Subsequent VisitSubsequent Visit

Pneumatic WalkerSuggested Code: L4360DMEPOS Fee Ceiling: $312

Severe

Ossur Equalizer Low Top

Ossur Equalizer Premium Aircast SP Walker Aircast FP Walker

Posterior Tibialis Posterior Tibialis TendonitisTendonitis

726.72726.72 Tibialis tendonitisTibialis tendonitis 905.8 905.8 Late effect of tendon injury, sprain, strainLate effect of tendon injury, sprain, strain

Posterior Tibialis Posterior Tibialis Tendonitis, Mild: Tendonitis, Mild: Initial Initial

VisitVisit

Aircast Airlift PTTDSuggested Code: L1906DMEPOS Fee Ceiling: $135

PowerStep InsertSuggested Code: L2999

Patient Pays

Posterior Tibialis Tendonitis, Posterior Tibialis Tendonitis, ModerateModerate: Initial Visit: Initial Visit

Donjoy Velocity ESSuggested Code: L1971DMEPOS Fee Ceiling: $505

Posterior Tibial Tendonitis: Posterior Tibial Tendonitis: Severe, Initial VisitSevere, Initial Visit




Posterior Tibialis Strain, Posterior Tibialis Strain, Moderate : Subsequent Moderate : Subsequent

VisitVisit

Night Splint, posterior or dorsal

Suggested Code: L4396DMEPOS Fee Ceiling: $180

Ossur AirformOssur Formfit Ossur Exoform

Posterior Tibialis, Posterior Tibialis, Rupture, Stage 3Rupture, Stage 3

727.68727.68 Rupture, tendon of foot and ankle, non-Rupture, tendon of foot and ankle, non- traumatictraumatic 728.4728.4 Laxity of ligamentLaxity of ligament 734734 Flat foot, acquiredFlat foot, acquired

Posterior Tibialis Strain, Posterior Tibialis Strain, Rupture, Stage 3: Initial Rupture, Stage 3: Initial

VisitVisit




Posterior Tibialis Posterior Tibialis Strain, Rupture, Stage Strain, Rupture, Stage

3: 3: Subsequent Visit, if getting Subsequent Visit, if getting

betterbetter

Aircast Airlift PTTDSuggested Code: L1906DMEPOS Fee Ceiling: $135

Less Severe


More Severe

Posterior Tibialis Strain, Rupture, Posterior Tibialis Strain, Rupture, Stage 3: Stage 3:

Subsequent Visit, if getting worseSubsequent Visit, if getting worse

Arizona AFOSuggested Code: L1940, L2330, L2820DMEPOS Fee Ceiling: $1099

Richie AFOSuggested Code: L1970, L2820DMEPOS Fee Ceiling: $901

Ankle Sprain, Grade 1Ankle Sprain, Grade 1

845.02845.02 Sprain and strain of ankle and foot, Sprain and strain of ankle and foot, calcaneofibular calcaneofibular

845.00845.00 Sprain and strain of ankle and foot, Sprain and strain of ankle and foot, unspecified siteunspecified site

729.5729.5 Pain in limbPain in limb 719.07 719.07 Unspecified disorder of ankle and footUnspecified disorder of ankle and foot

http://images.google.com/imgres?imgurl=http://www.healthsystem.virginia.edu/internet/orthopaedics/images/ankle.JPG&imgrefurl=http://www.healthsystem.virginia.edu/internet/orthopaedics/akspra.cfm&h=1226&w=1188&sz=114&hl=en&start=14&tbnid=esO0m6fRTdonUM:&tbnh=150&tbnw=145&prev=/images?q=ankle+sprain&gbv=2&svnum=10&hl=en&sa=G

Ankle Sprain, Grade 1Ankle Sprain, Grade 1: : Initial VisitInitial Visit

Ossur GamedaySuggested Code: L1906DMEPOS Fee Ceiling: $135

Ankle Sprain, Grade 2, 3Ankle Sprain, Grade 2, 3

729.5729.5 Ankle pain and supportAnkle pain and support 719.07 719.07 Effusion of joint, ankle, footEffusion of joint, ankle, foot 845.02845.02 Sprain and strain of ankle and foot, calcaneofibularSprain and strain of ankle and foot, calcaneofibular 845.01845.01 Sprain and strain of ankle and foot, deltoid ligamentSprain and strain of ankle and foot, deltoid ligament 824.2824.2 Ankle fracture, lateral malleolus onlyAnkle fracture, lateral malleolus only 824.6824.6 Ankle fracture, trimalleolarAnkle fracture, trimalleolar

Ankle Sprain, Grade 2, 3: Ankle Sprain, Grade 2, 3:

Initial VisitInitial Visit




Ankle Sprain, Grade 2, Ankle Sprain, Grade 2, 3: 3: Follow up visit, 2 - 6 Follow up visit, 2 - 6

weeksweeks



Delayed HealingHealing Well

Pediatric FracturePediatric Fracture

729.5729.5 Ankle pain and supportAnkle pain and support 719.07 719.07 Unspecified disorder of ankle and footUnspecified disorder of ankle and foot 845.02845.02 Sprain and strain of ankle and foot, calcaneofibularSprain and strain of ankle and foot, calcaneofibular 845.01845.01 Sprain and strain of ankle and foot, deltoid ligamentSprain and strain of ankle and foot, deltoid ligament 824.2824.2 Ankle fracture, lateral malleolus onlyAnkle fracture, lateral malleolus only 824.6824.6 Ankle fracture, trimalleolarAnkle fracture, trimalleolar

Pediatric Fracture: Pediatric Fracture: Initial VisitInitial Visit

Pneumatic Walker, Pediatric SizeSuggested Code: L4360DMEPOS Fee Ceiling: $312

Aircast SP WalkerAircast XP Walker

Pediatric Fracture: Pediatric Fracture: Follow up visit, 7 - 9 Follow up visit, 7 - 9

weeksweeks

Aircast Air-Stirrup, pediatric sizeSuggested Code: L4350DMEPOS Fee Ceiling: $100

Ankle Ankle InstabilityInstability

845.02 845.02 Sprain and strain of ankle and foot, Sprain and strain of ankle and foot, calcaneofibularcalcaneofibular

845.00845.00 Sprain and strain of ankle and foot, Sprain and strain of ankle and foot, unspecifiedunspecified

Ankle Instability: Initial Ankle Instability: Initial VisitVisit

Mild Moderate



Tarsal Tunnel SyndromeTarsal Tunnel Syndrome

355.5355.5 Tarsal tunnel syndromeTarsal tunnel syndrome 719.47 719.47 Pain in joint, ankle, footPain in joint, ankle, foot

Tarsal Tunnel SyndromeTarsal Tunnel Syndrome: :

Initial VisitInitial VisitMild



Moderate

Tarsal Tunnel Syndrome, Tarsal Tunnel Syndrome, severesevere: :





Peroneal TendonitisPeroneal Tendonitis

??????????????????

Peroneal TendonitisPeroneal Tendonitis: : Initial VisitInitial Visit

Mild, Moderate


Peroneal Tendonitis, Peroneal Tendonitis, severesevere: :





Peroneal TendonitisPeroneal Tendonitis: : Subsequent VisitSubsequent Visit

Severe


Sinus Tarsi SyndromeSinus Tarsi Syndrome

726.79726.79 Enthesopathy of ankle and tarsus, Enthesopathy of ankle and tarsus, otherother

719.47 719.47 Pain in joint, ankle, footPain in joint, ankle, foot

Sinus Tarsi SyndromeSinus Tarsi Syndrome: : Initial VisitInitial Visit

Mild



Moderate

Sinus Tarsi SyndromeSinus Tarsi Syndrome: : Initial VisitInitial Visit




Severe Sinus Tarsi Severe Sinus Tarsi SyndromeSyndrome: :

Subsequent VisitSubsequent Visit


Drop FootDrop Foot

736.79736.79 Acquired deformity of foot and ankleAcquired deformity of foot and ankle 438.20 438.20 HemiplegiaHemiplegia 719.97719.97 Joint derangement, ankle and footJoint derangement, ankle and foot 356.1356.1 Peroneal muscle atrophy, Charcot Marie Tooth Peroneal muscle atrophy, Charcot Marie Tooth

diseasedisease 340340 Multiple sclerosisMultiple sclerosis 138138 Poliomyelitis, late effectsPoliomyelitis, late effects 728.85728.85 Spasm of muscleSpasm of muscle

Flaccid Drop FootFlaccid Drop Foot : : Initial VisitInitial Visit

Euro International Peromax


Ossur DynamicSuggested Code: L1951DMEPOS Fee Ceiling: $905

Arizona Dorsiflex AssistSuggested Code: L1940,

L2210, L2330, L2820DMEPOS Fee Ceiling: $1174

Richie Dynamic AssistSuggested Code: L1970,

L2210, L2820DMEPOS Fee Ceiling: $976

Spastic Drop Foot : Initial Visit

Rigid Equinovarus

• 736.71 Equinovarus, acquired• 754.51 Equinovarus, congenital• 728.85 Spasm of muscle

Rigid EquinovarusRigid Equinovarus: : Initial VisitInitial Visit

Arizona AFO, Tall, foot plate to sulcus

Suggested Code: L1940, L2330, L2820

DMEPOS Fee Ceiling: $1099

Arizona AFO, ExtendedSuggested Code: L1960,

L2330, L2820DMEPOS Fee Ceiling: $1179

Achilles Achilles Tendonitis, Tendonitis,

Achilles Achilles Tendon TearTendon Tear

845.09845.09 Achilles tendon strain, Achilles tendon strain, teartear

726.71 726.71 Achilles tendonitisAchilles tendonitis

Achilles Tendonitis, Achilles Tendonitis, Achilles Tendon TearAchilles Tendon Tear::





Achilles Tendonitis, Achilles Tendonitis, Achilles Tendon TearAchilles Tendon Tear: :

Second visitSecond visit

Night Splint, posterior or dorsal


Ossur AirformOssur Formfit Ossur Exoform

Achilles Tendonitis, Achilles Tendonitis, Achilles Tendon TearAchilles Tendon Tear: :

Follow up visitFollow up visit

Bauerfeind AchilleotrainSuggested Code: L1902DMEPOS Fee Ceiling: $90.11

Metatarsal Metatarsal FractureFracture

733.10733.10 Stress fracture, unspecifiedStress fracture, unspecified 825.25 825.25 Fracture of the metatarsal boneFracture of the metatarsal bone

Metatarsal FractureMetatarsal Fracture: : Initial visitInitial visit

Ossur Equalizer Low Top WalkerSuggested Code: L4386DMEPOS Fee Ceiling: $171

Darco Med-Surg WalkerSuggested Code: L2999DMEPOS Fee Ceiling: Patient pays

Metatarsal FractureMetatarsal Fracture: : Follow up visitFollow up visit

PowerStep readymade orthotic

Suggested Code: L2999DMEPOS Fee Ceiling: Patient pays

Charcot, ActiveCharcot, Active

713.5713.5 Arthoropathy associated with Arthoropathy associated with neurological disorderneurological disorder

715.17 715.17 Osteoarthritis, localized foot and ankleOsteoarthritis, localized foot and ankle

Charcot, Charcot, Active,Active,

Goals of Goals of TreatmentTreatment

Prevent further deformityPrevent further deformity Obtain a plantargrade footObtain a plantargrade foot Avoid excess pressure on skinAvoid excess pressure on skin

Charcot, Charcot, Active:Active:


Total Contact Cast, non-

weight-bearingAircast XP Diabetic

WalkerSuggested Code: L4360DMEPOS Fee Ceiling: $312

Bledsoe Charcot Conformer


Charcot, Charcot, Active,Active,

Follow-up VisitFollow-up Visit

CROW if patient non-compliant and bearing weight

Suggested Code: L1960, L2340, L2820DMEPOS Fee Ceiling: $1228

Charcot, StaticCharcot, Static

715.17 715.17 Osteoarthritis, localized foot and ankleOsteoarthritis, localized foot and ankle 735.9735.9 Unspecified deformity of ankle and Unspecified deformity of ankle and

foot, acquiredfoot, acquired

Charcot, Static, Charcot, Static, TreatmentTreatment

Custom mold shoes, offset heels and rocker bottoms

Suggested Code: A5501, A5506, A5503

DMEPOS Fee Ceiling: $519

AZ AFO with removable footbed and Custom mold shoes

Suggested Code: L1940, L2330, L2820, A5501, A5506,

A5503DMEPOS Fee Ceiling: $1618

Disclaimer:Disclaimer:Suggested codes are based on publically available information and are offered as a convenience to physicians. The authors make no claims, promises or guarantees as to the availability of reimbursement for any of the suggested products. It is within the sole discretion of the physicians to determine the appropriate billing code for a product as well as whether the use of a product complies with medical necessity and other documentation requirements of the payor. The authors and the American Academy of Podiatric Practice Management accept no responsibility whatsoever in this regard.

Thank You!

Documents

Dx. Specific DME Protocols MPMA Summer Meeting